REGISTRATION FORM
Session*:
2023-2024
Mode of Admission*:
-Select-
Through Counselling
Through AICTE
Direct
Type of Admission*:
-Select-
Regular
TFW
EWS
PMSS
Management Quota
Vacant
Category:
-Select-
GEN
OBC
SC
ST
Lateral*:
Yes
No
Course*:
-Select-
B.Tech.
BCA
BBA
M.Tech.(CSE)
Priority(1st):
-Select-
B.Tech.(CSE)
B.Tech.(AIML)
B.Tech.(DS)
B.Tech.(IT)
B.Tech.(ECE)
B.Tech.(ME)
Priority(2nd):
-Select-
B.Tech.(CSE)
B.Tech.(AIML)
B.Tech.(DS)
B.Tech.(IT)
B.Tech.(ECE)
B.Tech.(ME)
Priority(3rd):
-Select-
B.Tech.(CSE)
B.Tech.(AIML)
B.Tech.(DS)
B.Tech.(IT)
B.Tech.(ECE)
B.Tech.(ME)
Student Name(As per 10th Marksheet)*:
Father's Name(As per 10th Marksheet)*:
Student Mobile No.*:
Aadhar Card No.*:
EMail Id.*:
Personal Detail
Student Name(First Name):
Middle Name:
Last Name:
Student Name(In Hindi):
Mother's Name(As per 10th Marksheet):
Address for Correspondence:
Pincode:
Is Permanent Address same as Address for communication:
Permanent Address:
Pincode:
State:
-Select-
ANDAMAN AND NICO.IN.
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHATTISGARH
DADRA AND NAGAR HAV.
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGALAYA
MIZORAM
NAGALAND
ODISHA
PONDICHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
District/City:
-Select-
Post-Office:
-Select-
Tehsil/Village:
Country:
Landline No.:
Domicile:
U.P.
Other than U.P.
Father Mobile No.:
Alternate Contact No.:
EMail Id.:
Aadhar No.:
Mother Mobile No.:
Alternate Contact No.:
EMail Id.:
Aadhar No.:
Father's Occupation:
Designation:
Qualification:
Mother's Occupation:
Designation:
Qualification:
Father Annual Income:
Mother Annual Income:
Date of Birth:
Blood Group:
-Select-
A+
A-
B+
B-
O+
O-
AB+
AB-
PAN Card No.:
Nationality:
Gender:
MALE
FEMALE
OTHERS
Religion:
Hinduism
Muslim/Islam
Christianity
Sikhism
Buddhism
Jainism
Zoroastrianism
Others
Minority:
Muslim
Christian
Sikh
Buddhist
Jain
Zoroastrian
Farsi
N.A.
Apply for Scholarship:
Yes
No
KM:
EX-S:
PH:
FF:
AF:
KM: Kashmiri Migrants, EX-S: Ex-Serviceman, PH: Physically Handicapped, FF: Freedom Fighter; AF: Armed Forces
Academic Detail
10th Result
Roll No.:
School Name:
Board Name:
-Select-
ALIGARH MUSLIM UNIVERSITY,ALIGARH
ANDHRA PRADESH OPEN SCHOOL SOCIETY
ANDHRA PRADESH BOARD OF INTERMEDIATE EDUCATION
ASSAM HIGHER SECONDARY EDUCATION COUNCIL
ASSAM SANSKRIT BOARD (GUWAHATI)
BANASTHALI VIDYAPITH
BHUTAN HIGHER SECONDARY EDUCATION CERTIFICATE (BHSEC)
BIHAR BOARD OF OPEN SCHOOLING AND EXAMINATION,PATNA,BIHAR
BIHAR INTERMEDIATE EDUCATION COUNCIL,PATNA (BIEC)
BIHAR SANSKRIT SHIKSHA BOARD,PATNA
BIHAR SCHOOL EXAMINATION BOARD,PATNA
BIHAR STATE MADRASA EDUCATION BOARD,PATNA
BOARD OF HIGH SCHOOL AND INTERMEDIATE EDUCATION,UTTAR PRADESH
BOARD OF SECONDARY EDUCATION,ANDHRA PRADESH
BOARD OF SECONDARY EDUCATION,ASSAM,BAMUNIMAIDAN,GUWAHATI
BOARD OF SECONDARY EDUCATION,MANIPUR,IMPHAL
BOARD OF SECONDARY EDUCATION,ODISHA
BOARD OF SECONDARY EDUCATION,RAJASTHAN,AJMER
CBSE I (CBSE INTERNATIONAL)
CENTRAL BOARD OF SECONDARY EDUCATION,NEW DELHI
CHHATTISGARH BOARD OF OPEN SCHOOL RAIPUR
CHHATTISGARH BOARD OF SECONDARY EDUCATION,RAIPUR
CHHATTISGARH MADRASA BOARD
CHHATTISGARH SANSKRIT BOARD,RAIPUR
COUNCIL FOR THE INDIAN SCHOOL CERTIFICATE EXAMINATION
COUNCIL OF HIGHER SECONDARY EDUCATION,MANIPUR
COUNCIL OF HIGHER SECONDARY EDUCATION,ODISHA
DAYALBAGH EDUCATIONAL INSTITUTE (DEEMED UNIVERSITY),AGRA
EDEXCEL,LONDON (UK)
GOA BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION
GUJRAT SECONDARY & HIGHER SECONDARY EDUCATION BOARD
HARYANA BOARD OF SCHOOL EDUCATION
HIGHER SECONDARY EDUCATION GOVT OF KERALA,THIRUVANANTHAPURAM
HIMACHAL PRADESH BOARD OF SCHOOL EDUCATION
INTERNATIONAL BACCALAUREATE
INTERNATIONAL GENERAL CERTIFICATE OF SECONDARY EDUCATION
J S S KARNATAKA OPEN SCHOOL
JAMIA MILIA ISLAMIA,NEW DELHI
JAMMU & KASHMIR STATE BOARD OF SCHOOL EDUCATION
JHARKHAND ACADEMIC COUNCIL,RANCHI
KARNATAKA BOARD OF THE PRE-UNIVERSITY EDUCATION
KARNATAKA SECONDARY EDUCATION EXAMINATION BOARD
KERALA BOARD OF PUBLIC EXAMINATIONS
KERALA STATE OPEN SCHOOL,THIRUVANANTHAPURAM
MADHYA PRADESH BOARD OF SECONDARY EDUCATION
MADHYA PRADESH STATE OPEN SCHOOL ,BHOPAL
MAHARASHTRA STATE BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION
MAHARISHI PATANJALI SANSKRIT SANSTHAN,BHOPAL
MEGHALAYA BOARD OF SCHOOL EDUCATION
MIZORAM BOARD OF SCHOOL EDUCATION
NAGALAND BOARD OF SCHOOL EDUCATION
NATIONAL INSTITUTE OF OPEN SCHOOLING,NOIDA(NOT ELIGIBLE FOR PHARMACY COURSE)
PUNJAB SCHOOL EDUCATION BOARD
RAJASTHAN STATE OPEN SCHOOL,JAIPUR
RAJIV GANDHI UNIVERSITY OF KNOWLEDGE TECHNOLOGIES,HYDERABAD
RASTRIYA SANSKRIT SANSTHAN
SCHOOL EDUCATION DEPARTMENT,GOVT OF TAMIL NADU
TAMIL NADU BOARD OF HIGHER SECONDARY EDUCATION
TELANGANA OPEN SCHOOL SOCIETY
TELENGANA BOARD OF INTERMEDIATE EDUCATION
THE HARYANA OPEN SCHOOL
THE JAMMU & KASHMIR STATE OPEN SCHOOL
THE KERALA STATE HIGHER EDUCATION COUNCIL
THE WEST BENGAL COUNCIL OF RABINDRA OPEN SCHOOLING
TRIPURA BOARD OF SECONDARY EDUCATION
U. P. BOARD OF SECONDARY SANSKRIT EDUCATION COUNCIL
UTTAR PRADESH STATE OPEN SCHOOL BOARD
UTTARAKHAND BOARD OF SCHOOL EDUCATION
UTTRANCHAL SIKSHA EVAM PARIKSHA PARISAD
VISHWA BHARTI UNIVERSITY,SHANTI NIKETAN,BIRBHUM,WB
VOCATIONAL HIGHER SECONDARY EDUCATION DEPARTMENT,GOVT OF KERALA
WEST BENGAL BOARD OF MADRASA EDUCATION
WEST BENGAL COUNCIL OF HIGHER SECONDARY EDUCATION
WEST BENGAL STATE COUNCIL OF VOCATIONAL EDUCATION & TRAINING
Medium:
Hindi
English
Passing State:
U.P.
Other than U.P.
Passing Year:
Marks Obtained:
Maximum Marks:
(%age)/CGPA:
Division:
-Select-
Ist Division
2nd Division
3rd Division
12th Result
Roll No.:
School Name:
Board Name:
-Select-
ALIGARH MUSLIM UNIVERSITY,ALIGARH
ANDHRA PRADESH OPEN SCHOOL SOCIETY
ANDHRA PRADESH BOARD OF INTERMEDIATE EDUCATION
ASSAM HIGHER SECONDARY EDUCATION COUNCIL
ASSAM SANSKRIT BOARD (GUWAHATI)
BANASTHALI VIDYAPITH
BHUTAN HIGHER SECONDARY EDUCATION CERTIFICATE (BHSEC)
BIHAR BOARD OF OPEN SCHOOLING AND EXAMINATION,PATNA,BIHAR
BIHAR INTERMEDIATE EDUCATION COUNCIL,PATNA (BIEC)
BIHAR SANSKRIT SHIKSHA BOARD,PATNA
BIHAR SCHOOL EXAMINATION BOARD,PATNA
BIHAR STATE MADRASA EDUCATION BOARD,PATNA
BOARD OF HIGH SCHOOL AND INTERMEDIATE EDUCATION,UTTAR PRADESH
BOARD OF SECONDARY EDUCATION,ANDHRA PRADESH
BOARD OF SECONDARY EDUCATION,ASSAM,BAMUNIMAIDAN,GUWAHATI
BOARD OF SECONDARY EDUCATION,MANIPUR,IMPHAL
BOARD OF SECONDARY EDUCATION,ODISHA
BOARD OF SECONDARY EDUCATION,RAJASTHAN,AJMER
CBSE I (CBSE INTERNATIONAL)
CENTRAL BOARD OF SECONDARY EDUCATION,NEW DELHI
CHHATTISGARH BOARD OF OPEN SCHOOL RAIPUR
CHHATTISGARH BOARD OF SECONDARY EDUCATION,RAIPUR
CHHATTISGARH MADRASA BOARD
CHHATTISGARH SANSKRIT BOARD,RAIPUR
COUNCIL FOR THE INDIAN SCHOOL CERTIFICATE EXAMINATION
COUNCIL OF HIGHER SECONDARY EDUCATION,MANIPUR
COUNCIL OF HIGHER SECONDARY EDUCATION,ODISHA
DAYALBAGH EDUCATIONAL INSTITUTE (DEEMED UNIVERSITY),AGRA
EDEXCEL,LONDON (UK)
GOA BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION
GUJRAT SECONDARY & HIGHER SECONDARY EDUCATION BOARD
HARYANA BOARD OF SCHOOL EDUCATION
HIGHER SECONDARY EDUCATION GOVT OF KERALA,THIRUVANANTHAPURAM
HIMACHAL PRADESH BOARD OF SCHOOL EDUCATION
INTERNATIONAL BACCALAUREATE
INTERNATIONAL GENERAL CERTIFICATE OF SECONDARY EDUCATION
J S S KARNATAKA OPEN SCHOOL
JAMIA MILIA ISLAMIA,NEW DELHI
JAMMU & KASHMIR STATE BOARD OF SCHOOL EDUCATION
JHARKHAND ACADEMIC COUNCIL,RANCHI
KARNATAKA BOARD OF THE PRE-UNIVERSITY EDUCATION
KARNATAKA SECONDARY EDUCATION EXAMINATION BOARD
KERALA BOARD OF PUBLIC EXAMINATIONS
KERALA STATE OPEN SCHOOL,THIRUVANANTHAPURAM
MADHYA PRADESH BOARD OF SECONDARY EDUCATION
MADHYA PRADESH STATE OPEN SCHOOL ,BHOPAL
MAHARASHTRA STATE BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION
MAHARISHI PATANJALI SANSKRIT SANSTHAN,BHOPAL
MEGHALAYA BOARD OF SCHOOL EDUCATION
MIZORAM BOARD OF SCHOOL EDUCATION
NAGALAND BOARD OF SCHOOL EDUCATION
NATIONAL INSTITUTE OF OPEN SCHOOLING,NOIDA(NOT ELIGIBLE FOR PHARMACY COURSE)
PUNJAB SCHOOL EDUCATION BOARD
RAJASTHAN STATE OPEN SCHOOL,JAIPUR
RAJIV GANDHI UNIVERSITY OF KNOWLEDGE TECHNOLOGIES,HYDERABAD
RASTRIYA SANSKRIT SANSTHAN
SCHOOL EDUCATION DEPARTMENT,GOVT OF TAMIL NADU
TAMIL NADU BOARD OF HIGHER SECONDARY EDUCATION
TELANGANA OPEN SCHOOL SOCIETY
TELENGANA BOARD OF INTERMEDIATE EDUCATION
THE HARYANA OPEN SCHOOL
THE JAMMU & KASHMIR STATE OPEN SCHOOL
THE KERALA STATE HIGHER EDUCATION COUNCIL
THE WEST BENGAL COUNCIL OF RABINDRA OPEN SCHOOLING
TRIPURA BOARD OF SECONDARY EDUCATION
U. P. BOARD OF SECONDARY SANSKRIT EDUCATION COUNCIL
UTTAR PRADESH STATE OPEN SCHOOL BOARD
UTTARAKHAND BOARD OF SCHOOL EDUCATION
UTTRANCHAL SIKSHA EVAM PARIKSHA PARISAD
VISHWA BHARTI UNIVERSITY,SHANTI NIKETAN,BIRBHUM,WB
VOCATIONAL HIGHER SECONDARY EDUCATION DEPARTMENT,GOVT OF KERALA
WEST BENGAL BOARD OF MADRASA EDUCATION
WEST BENGAL COUNCIL OF HIGHER SECONDARY EDUCATION
WEST BENGAL STATE COUNCIL OF VOCATIONAL EDUCATION & TRAINING
Medium:
Hindi
English
Passing State:
U.P.
Other than U.P.
Passing Year:
Marks Obtained:
Maximum Marks:
(%age):
Division:
-Select-
Ist Division
2nd Division
3rd Division
Physics:
/
Math.:
/
Chemistry/Biotech/Biology/IP:
/
PCM(%age):
English:
/
Computer:
/
Diploma Holder(Lateral Entry)
Roll No.:
School/College Name:
Board/University Name:
Medium:
Hindi
English
Passing State:
U.P.
Other than U.P.
Passing Year:
Marks Obtained:
Maximum Marks:
(%age)/CGPA:
Division:
-Select-
Ist Division
2nd Division
3rd Division
Entrance Detail
JEE Main:
Appeared
Not Appeared
Roll No.:
JEE Rank:
Category Rank:
Score/Percentile:
GATE:
Appeared
Not Appeared
Roll No.:
GATE Rank:
Category Rank:
Score/Percentile:
Other:
Roll No.:
Other Rank:
Category Rank:
Score/Percentile:
Other Detail
Sibling Studied/Studying from IPEC:
Yes
No
Passing Year:
Reference of IPEC:
Word of Mouth
News Paper
Website
Social Media
Any Other
Photograph:
Student photograph must be png/jpg/jpeg file format. Also, maximum file size must be less than 50kb.